Nasal fractures are often the result of trauma to the face, such as from contact sports, vehicle accidents, fights and falls. Nasal fractures are one of the most common types of facial fracture, accounting for approximately 40% of facial fractures. It is not uncommon for other facial fractures or injuries to occur at the same time as the nasal fracture. Particularly in instances of trauma, it is also important to ensure that there is no injury to the cervical spine. Because the nose is such a prominent part of the face, it is vulnerable to injury.
Anatomy of the nose
The nose is comprised of both bony and cartilaginous parts. The superior (top) and posterior (rear) parts of the nose are the bony parts. The bones of the nose are the paired nasal bones, which make up the bridge of the nose. Parts of the maxilla, the bone that forms the top jaw, called the frontal processes also form part of the nose. The frontal processes attach to the lacrimal bone (which helps to form the tear duct) to form the lateral (side) part of the upper nose. In the midline of the nose, the rear part of the nasal septum is made of the perpendicular plate of the ethmoid bone. The floor of the nose is made up of the palatine bone and part of the maxilla, whereas the roof of the nose is formed by the cribriform plate of the ethmoid bone. The vomer is a tiny bone that helps to form the choanae, which are the openings at the back of the nose that lead into the pharynx (throat). On the wall of each nostril are 3 tiny bones; the superior, middle and inferior conchae. These are bony shelves which are involved in humidifying the air we breathe.
The inferior (bottom) part of the nose is mainly made up of several plates of cartilage. The anterior (front) part of the septum, the structure which internally divides the nose into two nostrils, is also cartilaginous. The cartilages are flexible structures and can resist impact better than the bony parts. The nasal bones are most likely to fracture. Although the cartilages do not fracture; they can be injured by trauma to the nose. For example, haematomas (collections of blood outside of the blood vessels) can form in the cartilage of the nasal septum.
Signs and Symptoms
Usually, the most obvious sign of a nasal fracture is profuse bleeding from the nose (epistaxis). The nose has a rich blood supply and as a result, nasal fractures are frequently accompanied by bleeding from the nostrils. Nasal fractures can also cause pain, particularly across the bridge of the nose. As the structure of the nose is deformed by a fracture, patients find it difficult to breathe through their nose. The nose and face can become quite swollen and bruised. It is also common for someone with a broken nose to experience a black eye (or black eyes) a day or two after the fracture.
Management
Nasal fractures are treated differently according to the severity of the injury. Simple, well-aligned fractures of the nose may not require much more treatment than ice packs to alleviate pain and swelling, analgesia, rest and care not to further injure the nose. Severe, displaced fractures may require surgery. X-rays and CT scans are not always required to diagnose a broken nose, but may be required in the case of severe fractures or if other facial fractures are suspected.
If the fracture results in a poorly aligned nose, there are several options to reduce the fracture. If the misalignment is not too severe, the nose may be realigned without surgery. The nose can be reduced back into place and supported by packing inside the nostrils and a splint externally. However, if this is not achievable, surgical correction may be required. Surgery is particularly important if the fracture has altered the structure of the nose in a way that nasal breathing is obstructed, or if the fracture will not heal in the position it is in. Surgery is also important for cosmetic reasons. If surgery is not performed within 2 weeks of the injury, you may need to wait a few months for the swelling to subside so that the procedure can be performed.
If you have questions about nose surgery or are interested in rhinoplasty make an appointment to see our nose surgeon.
